Basic Information
| Provider Information | |||||||||
| NPI: | 1114370897 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WIGGINS | ||||||||
| FirstName: | TANIKA | ||||||||
| MiddleName: | |||||||||
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| Credential: | LGSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5083 BLUEHEAD CT | ||||||||
| Address2: | |||||||||
| City: | WALDORF | ||||||||
| State: | MD | ||||||||
| PostalCode: | 206034711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4437412554 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9701 PHILADELPHIA CT | ||||||||
| Address2: | SUITE R | ||||||||
| City: | LANHAM | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207064400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3014773339 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2016 | ||||||||
| LastUpdateDate: | 07/19/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 20842 | MD | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.